What You Need To Know About Cyclosporosis: The Parasitic Infection Causing Outbreaks In 16 States

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Some of the infections have been traced to imported prepackaged salads. (Photo credit: Wikipedia)

Cyclosporosis, a parasitic infection passed to humans via contaminated food or water, has sickened at least 504 people in 16 U.S. states since late June. Thirty people have been admitted to the hospital.

Reports of the microscopic parasite, usually found in tropical and subtropical climates, have been particularly prevalent in the Midwest, affecting 146 people in Iowa and 82 in Nebraska, with other reports coming from Illinois, Minnesota, Kansas and Missouri. Although the Centers for Disease Control (CDC) have traced the Iowa and Nebraska outbreaks to pre-packaged salad mixes that came from Mexico, the origin of the other infections isn’t yet known. Additional states that have reported cyclosporosis are Arkansas, Connecticut, Florida, Georgia, Louisiana, New Jersey, New York (including New York City), Ohio, Texas and Wisconsin.

Infections with cyclospora in North America are rare. Cyclosporosis was first identified in 1979 in Papua New Guinea and only found in the U.S. in 1995. While Americans can pick up the infection overseas and become ill after they arrive home, outbreaks among people who have not traveled internationally have been caused by contaminated imported produce, such as lettuce, snow peas, raspberries, and fresh basil.

People who ingest cyclospora generally develop severe, intense watery diarrhea and can also experience abdominal cramping, bloating, nausea, fatigue, and weight loss. “People should be concerned about cyclospora because unlike other diarrheal illness, it can cause symptoms that persist for several months,” says Robert B. Boughan, MD, an internist and pediatrician at Mercy Medical Center's Lutherville Personal Physicians, in Lutherville, Maryland. This is particularly worrisome for young children, the elderly, and people with compromised immune systems, such as those with HIV. Severe and/or extended diarrhea can lead to dehydration, which can lead to other health problems.

Cyclosporosis should be taken very seriously, says Boughan. “Treatment is not always necessary, but is usually recommended because of the duration of the symptoms.” This may be easier said than done, however. Not everyone is diagnosed in a timely manner for two reasons: first, the person who has the infection may not seek help right away, not realizing that the illness may have been caused by the parasite and second, because the doctor may not order the correct test. “The ova and parasite test that is routinely ordered for people who have suspected food poisoning or parasite illness doesn’t always catch cyclospora, so physicians need to order a very specific test,” Boughan explains. A course of antibiotics will generally eliminate the parasite.

Can cyclosporosis be prevented? Since the parasite is carried on contaminated produce, we can reduce our risk of contracting it by washing all produce, but we can’t eliminate the risk completely. “The best way is to be really aggressive just washing with water,” Boughan says. There isn’t one particular commercial product or vegetable wash that has been proven to be more effective than others for cyclospora and it’s not always possible to remove all the spores. “There’s speculation that there are some qualities of the shape and the morphology [of the spore] that physically make it difficult to dislodge from produce,” notes Boughan.

Even produce that is labeled ‘prewashed’ should be cleaned at home. “In this particular outbreak, it looks like it is most likely related to some of these prepared salads. A lot of times you’ll buy produce that says they’ve been triple washed, but we definitely recommend people wash even those products,” Boughan points out. Cyclospora cannot be transmitted from person to person. It takes seven days for the spores to become infectious.

I am an RN who moved from working in the healthcare system to writing about all things health-related. Working with patients and families, I learned that there are so many unknowns for them and many times, they don’t even know what to ask. By writing about these issues, I’m...